Addressing threats to health care's core values, especially those stemming from concentration and abuse of power. Advocating for accountability, integrity, transparency, honesty and ethics in leadership and governance of health care.

Sunday, May 03, 2015

Innovations form the Safra Center Ending iCorruption Conference

I had the pleasure of attending the Ending iCorruption Conference, the capstone conference for the Edmond J Safra Research Lab on Institutional Corruption, held at the Harvard Law School on May 1-2, 2015. The conference included much material relevant to health care corruption and related topics, and provided some innovative approaches that could be used to address these issues. I list these below, with citations or links when available. At some point in the future, all conference proceedings should be available on video from the Safra Center.

Uncovering Data on Conflicts of Interest

Unearth: Using PubMed to Uncover Conflicts of Interest Affecting Clinical Research

Unearth is a browser extension now available for Google Chrome, and soon to become available for other browsers, e.g., Firefox. It works on PubMed searches, scraping funding and conflict of interest data from the body of articles and adding them to abstracts. We have often discussed such conflicts of interest, and their relationship to manipulation of clinical research. Unearth could make such conflicts more salient, making it easier to discriminate unconflicted from conflicted research. (See this post on the Bill of Health blog.) This application was developed during the Safra Center Hacking iCorruption Event.

Open Think Tanks: Uncovering Think Tank Funding

Think tanks often publish findings on and make recommendations about health care. However, think tanks are often opaque, and any institutional conflicts of interest they have may not be easily apparent. Open Think Tanks currently shows donations from government entities outside the US to US based think tanks. Enhancements to include various kinds of private donations are likely in the future. This application was also developed during the Hacking iCorruption Event.

Finding Unconflicted Academics

As we have discussed, the majority of medical academics have conflicts of interest, which may affect their research, teaching and patient care. Yet these conflicts are not always disclosed. Furthermore, finding experts without conflicts is not easy. ProfessorCert is a website that allows academics who have no conflicts of interest to register as such. The website was developed by the Academic Independence Project.

Improving Integrity

Putting Consumers in the FDA and Other Regulatory Agencies

We have frequently discussed regulatory capture, how government health care regulatory agencies, like the US Food and Drug Administration (FDA), often seem to end up more concerned about the financial health of those they are supposed to regulate than patients' and the public's health. Harvard Prof Daniel Carpenter, collaborator in Safra Center research, talked about the problem of "cultural capture" of regulatory agencies, in which the regulators' thinking is influenced by outside vested interests. He proposed that regulatory agencies need to put consumers, or presumably other stakeholders like unconflicted health care professionals, "into the room."

Putting Ethicists in the C- Suite

We have frequently criticized the leadership of hospitals and hospital systems. In particular, we have discussed instances in which these leaders seem to have gone directly against the mission of their own organizations, which we termed mission hostile management. Safra Lab Network Fellow James Corbett, now Senior Vice President for Centura Health, proposed that ethicists who also understand the language of finance and management be present among the top leadership of hospital systems.

Licensing Executives

As noted above, a major theme of the Health Care Renewal blog is the shortcomings of the leadership of large health care organizations. Top leaders often have business training, but may be ill-informed about health care, and ignorant or unsupportive of or even hostile to its values. Wellesley College Professor Emerita Ann Congleton's 2014 article in the Journal of Business Ethics, entitled Beyond business ethics: an agenda for the trustworthy teachers and practitioners of business, proposed requiring that corporate executives, including executives of health care corporations, be licensed in order to lead their organizations. I proposed licensing of leaders of large health care organizations as early as 2008 (here).

Pharmaceutical Research Uninfluenced by the Pharmaceutical Industry

Because clinical research meant to evaluate drugs or devices sponsored
by manufacturers of the relevant products has shown to be frequently manipulated, or even suppressed,
many people have suggested banning such sponsorship and direct
influence of such manufacturers. (For example, see the book and blog, both entitled "Hooked," written by Dr Howard Brody, and see Health Care Renewal blog posts, e.g., here.)Safra Center Network Fellow and Rowan University Professor Donald Light's book in press, Good Pharma, basically offers proof of the concept that high quality clinical research on pharmaceuticals can be accomplished without industry money or influence, albeit in Italy, at the Mario Negri Institute.

Summary

The project on institutional corruption at the Safra Center produced a burst of innovation meant to address this pervasive project, and thus provided much of value to those who want to challenge health care corruption. I hope this innovation will turn out to be truly disruptive. It is regretful that this project has come to an end. We can only hope others pick up the banner.

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